Exercise, therapy and diet can all improve life during cancer treatment and boost survival. Here’s how
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With so many high-profile people diagnosed with cancer we are confronted with the stark reality the disease can strike any of us at any time. There are also reports certain cancers are increasing among younger people in their 30s and 40s.
On the positive side, medical treatments for cancer are advancing very rapidly. Survival rates are improving greatly and some cancers are now being managed more as long-term chronic diseases rather than illnesses that will rapidly claim a patient’s life.
The mainstays of cancer treatment remain surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and hormone therapy. But there are other treatments and strategies – “adjunct” or supportive cancer care – that can have a powerful impact on a patient’s quality of life, survival and experience during cancer treatment.
Keep moving if you can
Physical exercise is now recognised as a medicine. It can be tailored to the patient and their health issues to stimulate the body and build an internal environment where cancer is less likely to flourish. It does this in a number of ways.
Exercise provides a strong stimulus to our immune system, increasing the number of cancer-fighting immune cells in our blood circulation and infusing these into the tumour tissue to identify and kill cancer cells.
Our skeletal muscles (those attached to bone for movement) release signalling molecules called myokines. The larger the muscle mass, the more myokines are released – even when a person is at rest. However, during and immediately after bouts of exercise, a further surge of myokines is secreted into the bloodstream. Myokines attach to immune cells, stimulating them to be better “hunter-killers”. Myokines also signal directly to cancer cells slowing their growth and causing cell death.
Exercise can also greatly reduce the side effects of cancer treatment such as fatigue, muscle and bone loss, and fat gain. And it reduces the risk of developing other chronic diseases such as heart disease and type 2 diabetes. Exercise can maintain or improve quality of life and mental health for patients with cancer.
Emerging research evidence indicates exercise might increase the effectiveness of mainstream treatments such as chemotherapy and radiation therapy. Exercise is certainly essential for preparing the patient for any surgery to increase cardio-respiratory fitness, reduce systemic inflammation, and increase muscle mass, strength and physical function, and then rehabilitating them after surgery.
These mechanisms explain why cancer patients who are physically active have much better survival outcomes with the relative risk of death from cancer reduced by as much as 40–50%.
Mental health helps
The second “tool” which has a major role in cancer management is psycho-oncology. It involves the psychological, social, behavioural and emotional aspects of cancer for not only the patient but also their carers and family. The aim is to maintain or improve quality of life and mental health aspects such as emotional distress, anxiety, depression, sexual health, coping strategies, personal identity and relationships.
Supporting quality of life and happiness is important on their own, but these barometers can also impact a patient’s physical health, response to exercise medicine, resilience to disease and to treatments.
If a patient is highly distressed or anxious, their body can enter a flight or fight response. This creates an internal environment that is actually supportive of cancer progression through hormonal and inflammatory mechanisms. So it’s essential their mental health is supported.
Putting the good things in: diet
A third therapy in the supportive cancer care toolbox is diet. A healthy diet can support the body to fight cancer and help it tolerate and recover from medical or surgical treatments.
Inflammation provides a more fertile environment for cancer cells. If a patient is overweight with excessive fat tissue then a diet to reduce fat which is also anti-inflammatory can be very helpful. This generally means avoiding processed foods and eating predominantly fresh food, locally sourced and mostly plant based.
Muscle loss is a side effect of all cancer treatments. Resistance training exercise can help but people may need protein supplements or diet changes to make sure they get enough protein to build muscle. Older age and cancer treatments may reduce both the intake of protein and compromise absorption so supplementation may be indicated.
Depending on the cancer and treatment, some patients may require highly specialised diet therapy. Some cancers such as pancreatic, stomach, esophageal, and lung cancer can cause rapid and uncontrolled drops in body weight. This is called cachexia and needs careful management.
Other cancers and treatments such as hormone therapy can cause rapid weight gain. This also needs careful monitoring and guidance so that, when a patient is clear of cancer, they are not left with higher risks of other health problems such as cardiovascular disease and metabolic syndrome (a cluster of conditions that boost your risk of heart disease, stroke and type 2 diabetes).
Working as a team
These are three of the most powerful tools in the supportive care toolbox for people with cancer. None of them are “cures” for cancer, alone or together. But they can work in tandem with medical treatments to greatly improve outcomes for patients.
If you or someone you care about has cancer, national and state cancer councils and cancer-specific organisations can provide support.
For exercise medicine support it is best to consult with an accredited exercise physiologist, for diet therapy an accredited practising dietitian and mental health support with a registered psychologist. Some of these services are supported through Medicare on referral from a general practitioner.
For free and confidential cancer support call the Cancer Council on 13 11 20.
Rob Newton, Professor of Exercise Medicine, Edith Cowan University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Behavioral Activation Against Depression & Anxiety
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Behavioral Activation Against Depression & Anxiety
Psychologists do love making fancy new names for things.
You thought you were merely “eating your breakfast”, but now it’s “Happiness-Oriented Basic Behavioral Intervention Therapy (HOBBIT)” or something.
This one’s quite simple, so we’ll keep it short for today, but it is one more tool for your toolbox:
What is Behavioral Activation?
Behavioral Activation is about improving our mood (something we can’t directly choose) by changing our behavior (something we usually can directly choose).
An oversimplified (and insufficient, as we will explain, but we’ll use this one to get us started) example would be “whistle a happy tune and you will be happy”.
Behavioral Activation is not a silver bullet
Or if it is, then it’s the kind you have to keep shooting, because one shot is not enough. However, this becomes easier than you might think, because Behavioral Activation works by…
Creating a Positive Feedback Loop
A lot of internal problems in depression and anxiety are created by the fact that necessary and otherwise desirable activities are being written off by the brain as:
- Pointless (depression)
- Dangerous (anxiety)
The inaction that results from these aversions creates a negative feedback loop as one’s life gradually declines (as does one’s energy, and interest in life), or as the outside world seems more and more unwelcoming/scary.
Instead, Behavioral Activation plans activities (usually with the help of a therapist, as depressed/anxious people are not the most inclined to plan activities) that will be:
- attainable
- rewarding
The first part is important, because the maximum of what is “attainable” to a depressed/anxious person can often be quite a small thing. So, small goals are ideal at first.
The second part is important, because there needs to be some way of jump-starting a healthier dopamine cycle. It also has to feel rewarding during/after doing it, not next year, so short term plans are ideal at first.
So, what behavior should we do?
That depends on you. Behavioral Activation calls for keeping track of our activities (bullet-journaling is fine, and there are apps* that can help you, too) and corresponding moods.
*This writer uses the pragmatic Daylio for its nice statistical analyses of bullet-journaling data-points, and the very cute Finch for more keyword-oriented insights and suggestions. Whatever works for you, works for you, though! It could even be paper and pen.
Sometimes the very thought of an activity fills us with dread, but the actual execution of it brings us relief. Bullet-journaling can track that sort of thing, and inform decisions about “what we should do” going forwards.
Want a ready-made brainstorm to jump-start your creativity?
Here’s list of activities suggested by TherapistAid (a resource hub for therapists)
Want to know more?
You might like:
- How To Use Behavioral Activation (guide for end users)
- Treatment Guide: Behavioral Activation (guide for clinicians)
Take care!
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How To Beat Loneliness & Isolation
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Overcoming Loneliness & Isolation
One of the biggest mental health threats that faces many of us as we get older is growing isolation, and the loneliness that can come with it. Family and friends thin out over the years, and getting out and about isn’t always as easy as it used to be for everyone.
Nor is youth a guaranteed protection against this—in today’s world of urban sprawl and nothing-is-walkable cities, in which access to social spaces such as cafés and the like means paying the rising costs with money that young people often don’t have… And that’s without getting started on how much the pandemic impacted an entire generation’s social environments (or lack thereof).
Why is this a problem?
Humans are, by evolution, social creatures. As individuals we may have something of a spectrum from introvert to extrovert, but as a species, we thrive in community. And we suffer, when we don’t have that.
What can we do about it?
We can start by recognizing our needs, such as they are, and identifying to what extent they are being met (or not).
- Some of us may be very comfortable with a lot of alone time—but need someone to talk to sometimes.
- Some of us may need near-constant company to feel at our best—and that’s fine too! We just need to plan accordingly.
In the former case, it’s important to remember that needing someone to talk to is not being a burden to them. Not only will our company probably enrich them too, but also, we are evolved to care for one another, and that itself can bring fulfilment to them as much as to you. But what if you don’t a friend to talk to?
- You might be surprised at who would be glad of you reaching out. Have a think through whom you know, and give it a go. This can be scary, because what if they reject us, or worse, they don’t reject us but silently resent us instead? Again, they probably won’t. Human connection requires taking risks and being vulnerable sometimes.
- If that’s not an option, there are services that can fill your need. For some, therapy might serve a dual purpose in this regard. For others, you might want to check out the list of (mostly free) resources at the bottom of this article
In the second case (that we need near-constant company to feel at our best) we probably need to look more at our overall lifestyle, and find ways to be part of a community. That can include:
- Living in a close-knit community (places with a lot of retirees in one place often have this; or younger folk might look at communal living/working spaces, for example)
- Getting involved in local groups (you can check out NextDoor.com or MeetUp.com for this)
- Volunteering for a charity (not only are acts of service generally fulfilling in and of themselves, but also, you will probably be working with other people of a charitable nature, and such people tend to make for good company!)
Need a little help?
There are many, many organizations that will love to help you (or anyone else) overcome loneliness and isolation.
Rather than list them all here and make this email very long by describing how each of them works, here’s a great compilation of resources:
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The Comfort Zone – by Kristen Butler
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Are you sitting comfortably? Then we’ll begin. Funny, how being comfortable can be a good starting point, then we are advised “You have to get out of your comfort zone”.
And yet, when we think of our personal greatest moments in life, they were rarely uncomfortable moments. Why is that?
Kristen Butler wants us to resolve this paradox, with a reframe:
The comfort zone? That’s actually the “flow” zone.
Just as “slow and steady wins the race”, we can—like the proverbial tortoise—take our comfort with us as we go.
The discomfort zone? That’s the stress zone, the survival zone, the “putting out fires” zone. From the outside, it looks like we’re making a Herculean effort, and perhaps we are, but is it actually so much better than peaceful consistent productivity?
Butler writes in a way that will be relatable for many, and may be a welcome life-ring if you feel like you’ve been playing catch-up for a while.
Is she advocating for complacency, then? No, and she discusses this too. That “complacency zone” is really the “burnout zone” after being in the “survival zone” for too long.
She lays out for us, therefore, a guide for growing in comfort, expanding the comfort zone yes, but by securely pushing it from the inside, not by making a mad dash out and hoping it follows us.
Bottom line: if you’ve been (perhaps quietly) uncomfortable for a little too long for comfort, this book can reframe your approach to get you to a position of sustainable, stress-free growth.
Click here to check out The Comfort Zone, and start building yours!
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The Many Health Benefits Of Garlic
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The Many Health Benefits of Garlic
We’re quite confident you already know what garlic is, so we’re going to leap straight in there with some science today:
First, let’s talk about allicin
Allicin is a compound in garlic that gives most of its health benefits. A downside of allicin is that it’s not very stable, so what this means is:
- Garlic is best fresh—allicin breaks down soon after garlic is cut/crushed
- So while doing the paperwork isn’t fun, buying it as bulbs is better than buying it as granules or similar
- Allicin also breaks down somewhat in cooking, so raw garlic is best
- Our philosophy is: still use it in cooking as well; just use more!
- Supplements (capsule form etc) use typically use extracts and potency varies (from not great to actually very good)
Read more about that:
- Short-term heating reduces the anti-inflammatory effects of fresh raw garlic extracts
- Allicin Bioavailability and Bioequivalence from Garlic Supplements and Garlic Foods
Now, let’s talk benefits…
Benefits to heart health
Garlic has been found to be as effective as the drug Atenolol at reducing blood pressure:
It also lowers LDL (bad cholesterol):
Benefits to the gut
We weren’t even looking for this, but as it turns out, as an add-on to the heart benefits…
Benefits to the immune system
Whether against the common cold or bringing out the heavy guns, garlic is a booster:
- Preventing the common cold with a garlic supplement: a double-blind, placebo-controlled survey
- Supplementation with aged garlic extract improves both NK and γδ-T cell function and reduces the severity of cold and flu symptoms: a randomized, double-blind, placebo-controlled nutrition intervention
Benefits to the youthfulness of body and brain
Garlic is high in antioxidants that, by virtue of reducing oxidative stress, help slow aging. This effect, combined with the cholesterol and blood pressure benefits, means it may also reduce the risk of Alzheimer’s and other forms of dementia:
- Antioxidant health effects of aged garlic extract
- Effects of garlic consumption on plasma and erythrocyte antioxidant parameters in elderly subjects
- Garlic reduces heart disease and dementia risk
There are more benefits too…
That’s all we have time to dive into study-wise today, but for the visually-inclined, here are yet more benefits to garlic (at a rate of 3–4 cloves per day):
An incredible awesome recipe using lots of garlic:
- Take small potatoes (still in their skins), cut in half
- Add enough peeled cloves of garlic so that you have perhaps a 1:10 ratio of garlic to potato by mass
- Boil (pressure-cooking is ideal) until soft, and drain
- Keeping them in the pan, add a lashing of olive oil, and any additional seasonings per your preference (consider black pepper, rosemary, thyme, parsley)
- Put a lid on the pan, and holding it closed, shake the pan vigorously
- Note: if you didn’t leave the skins on, or you chopped much larger potatoes smaller instead of cutting in half, the potatoes will break up into a rough mash now. This is actually also fine and still tastes (and honestly, looks) great, but it is different, so just be aware, so that you get the outcome you want.
- The garlic, which—unlike the potatoes—didn’t have a skin to hold it together, will now have melted over the potatoes like butter
You can serve like this (it’s delicious already) or finish up in the oven or air-fryer or under the grill, if you prefer a roasted style dish (an amazing option too).
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- Garlic is best fresh—allicin breaks down soon after garlic is cut/crushed
Melatonin: A Safe, Natural Sleep Aid?
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Melatonin: A safe sleep supplement?
Melatonin is a hormone normally made in our pineal gland. It helps regulate our circadian rhythm, by making us sleepy.
It has other roles too—it has a part to play in regulating immune function, something that also waxes and wanes as a typical day goes by.
Additionally, since melatonin and cortisol are antagonistic to each other, a sudden increase in either will decrease the other. Our brain takes advantage of this, by giving us a cortisol spike in the morning to help us wake up.
As a supplement, it’s generally enjoyed with the intention of inducing healthy, natural, restorative sleep.
Does it really induce healthy, natural, restorative, sleep?
Yes! Well, “natural” is a little subject and relative, if you’re taking it as a supplement, but it’s something your body produces naturally anyway.
Contrast with, for example, benzodiazepines (that whole family of medications with names ending in -azopan or -alozam), or other tranquilizing drugs that do not so much induce healthy sleep, but rather reduce your brain function and hopefully knock you out, and/but often have unwanted side effects, and a tendency to create dependency.
Melatonin, unlike most of those drugs, does not create dependency, and furthermore, we don’t develop tolerance to it. In other words, the same dose will continue working (we won’t need more and more).
In terms of benefits, melatonin not only reduces the time to fall asleep and increases total sleep time, but also (quite a bonus) improves sleep quality, too:
Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders
Because it is a natural hormone rather than a drug with many side effects and interactions, it’s also beneficial for those who need good sleep and/but don’t want tranquilizing:
Any other benefits?
Yes! It can also help guard against Seasonal Affective Disorder, also called seasonal depression. Because SAD is not just about “not enough light = not enough serotonin”, but also partly about circadian rhythm and (the body is not so sure what time of day it is when there are long hours of darkness, or even, in the other hemisphere / other time of year, long hours of daylight), melatonin can help, by giving your brain something to “anchor” onto, provided you take it at the same time each day. See:
- Is seasonal affective disorder a disorder of circadian rhythms?
- The circadian basis of winter depression: the case for low-dose melatonin use
As a small bonus, melatonin also promotes HGH production (important for maintaining bone and muscle mass, especially in later life):
Anything we should worry about?
Assuming taking a recommended dose only (0.5mg–10mg per day), toxicity is highly unlikely, especially given that it has a half-life of only 40–60 minutes, so it’ll be eliminated quite quickly.
However! It does indeed induce sleepiness, so for example, don’t take melatonin and then try to drive or operate heavy machinery—or, ideally, do anything other than go to bed.
It can interfere with some medications. We mentioned that melatonin helps regulate immune function, so for example that’s something to bear in mind if you’re on immunosuppressants or otherwise have an autoimmune disorder. It can also interfere with blood pressure medications and blood thinners, and may make epilepsy meds less effective.
As ever, if in doubt, please speak with your doctor and/or pharmacist.
Where to get it?
As ever, we don’t sell it (or anything else), but for your convenience, here is an example product on Amazon.
Enjoy!
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Boundary-Setting Beyond “No”
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More Than A “No”
A lot of people struggle with boundary-setting, and it’s not always the way you might think.
The person who “can’t say no” to people probably comes to mind, but the problem is more far-reaching than that, and it’s rooted in not being clear over what a boundary actually is.
For example: “Don’t bring him here again!”
Pretty clear, right?
And while it is indeed clear, it’s not a boundary; it’s a command. Which may or may not be obeyed, and at the end of the day, what right have we to command people in general?
Same goes for less dramatic things like “Don’t talk to me about xyz”, which can still be important or trivial, depending on whether the topic of xyz is deeply traumatizing for you, or mildly annoying, or something else entirely.
Why this becomes a problem
It becomes a problem not because of any lack of clarity about your wishes, but rather, because it opens the floor for a debate. The listener may be given to wonder whether your right to not experience xyz is greater or lesser than their right to do/say/etc xyz.
“My right to swing my fist ends where someone else’s nose begins”
…does not help here, firstly because both sides will believe themself (or nobody) to be the injured party; for the fist-swinger, the other person’s nose made a vicious assault on their freedom. Or secondly, maybe there was some higher principle at stake; a reason why violence was justified. And then ten levels of philosophical debate. We see this a lot when it comes to freedom of expression, and vigorous debate over whether this entails freedom from social consequences of one’s words/actions.
How a good boundary-setting works (if this, then that)
Consider two signs:
- No trespassing!
- Trespassers will be shot!
Superficially, the second just seems like a more violent rendition of the first. But in fact, the second is more informationally useful: it explains what will happen if the boundary is not respected, and allows the reader to make their own informed decision with regard to what to do with that information.
We can employ this method (and can even do so gently, if we so wish and hopefully we mostly do wish to be gentle) when it comes to social and interpersonal boundary-setting:
- If you bring him here again, I will refuse you entrance
- If you bring up that topic again, I will ask you to leave
- If you do that, I will never speak to you again
- If you don’t stop drinking, I will divorce you
This “if-this-then-that” model does the very first thing that any good boundary does: make itself clear.
It doesn’t rely on moral arguments; it doesn’t invite debate. For example in that last case, it doesn’t argue that the partner doesn’t have the right to drink—it simply expresses what the speaker will exercise their own right to do, in that eventuality.
(as an aside, the situation that occurs when one is enmeshed with someone who is dependent on a substance is a complex topic, and if you’re interested in that, check out: Codependency Isn’t What Most People Think)
Back on track: boundary-setting is not about what’s right or good—it’s about nothing more nor less than a clear delineation between what we will and won’t accept, and how we’ll enforce that.
We can also, in particularly personal boundary-setting (such as with sexual boundaries’ oft-claimed “gray areas”), fix an improperly-set boundary that forgot to do the above, e.g:
“How about [proposition]?”
“No thank you” ← casually worded answer; contextually reasonable, and yet not a clear boundary per what we discussed above
“Come on, I think you’d like it”
“I said no. No means no. Ask me again and I will [consequences that are appropriate and actionable]”What’s “appropriate and actionable” may vary a lot from one situation to another, but it’s important that it’s something you can do and are prepared to do and will do if the condition for doing it is met.
Anything less than that is not a boundary—it’s just a request.
Note: this does not require that we have power, by the way. If we have zero power in a situation, well, that definitely sucks, but even then we can still express what is actionable, e.g. “I will never trust you again”.
“Price of entry”
You may have wondered, upon reading “boundary-setting is not about what’s right or good—it’s about nothing more nor less than a clear delineation between what we will and won’t accept, and how we’ll enforce that”, can’t that be used to control and manipulate people, essentially coercing them to do or not do things with the threat of consequences (specifically: bad ones)?
And the answer is: yes, yes it can.
But that’s where the flipside comes into play—the other person gets to set their boundaries, too.
For all of us, if we have any boundaries at all, there is a “price of entry” and all who want to be in our lives, or be close to us, have to decide for themselves whether that price of entry is worth it.
- If a person says “do not talk about topic xyz to me or I will leave”, that is a price of entry for being close to them.
- If you are passionate about talking about topic xyz to the point that you are unwilling to shelve it when in their presence, then that is the price of entry for being close to you.
- If one or more of you is not willing to pay the price of entry, then guess what, you’re just not going to be close.
In cases of forced proximity (e.g. workplaces or families) this is likely to get resolved by the workplace’s own rules (i.e. the price of entry that you agreed to when signing a contract to work there), and if something like that doesn’t exist (such as in families), well, that forced proximity is going to reach a breaking point, and somebody may discover it wasn’t enforceable after all.
See also: Family Estrangement: More Common Than Most People Think
…which also details how to fix it, where possible.
Take care!
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